Mehl. pulmo: TEF, choanal, diaph hernia, NRDS 04-03 (4)

Question 1

TEF = Tracheoesophageal fistula.
HY peds condition

Answer 1

.

Question 2

TEF. definition?

Answer 2

proximal esophagus ends in a blind pouch + the distal esophagus connects to the trachea.

Question 3

proximal esophagus ends in a blind pouch + the distal esophagus connects to the trachea.?

Answer 3

TEF = Tracheoesophageal fistula.

Question 4

TEF. CP?

Answer 4

Will present as a neonate who coughs up milk with initial feeding

Question 5

Will present as a neonate who coughs up milk with initial feeding?

Answer 5

TEF.

Question 6

TEF. what is highest yield point regarding diagnostic?

Answer 6

Highest yield point about TEF is that diagnosis is made via insertion of
nasogastric tube (which cannot be inserted fully because it hits the blind
pouch of the esophagus).

Question 7

TEF. embriology abnormality?

Answer 7

An NBME Q wants “endoderm” as the abnormal embryology for TEF (makes sense, since esophagus is epithelial lining of the gut -> endoderm)

Question 8

Weird condition in which the nasal passages don’t develop patency, so
the neonate is an obligate mouth-breather?

Answer 8

Choanal atresia.

Question 9

Choanal atresia. definition?

Answer 9

Weird condition in which the nasal passages don’t develop patency, so the neonate is an obligate mouth-breather

Question 10

Choanal atresia.
CP?

Answer 10

Will present as a child who becomes blue/hypoxic while breast feeding (because he can’t breathe through the nose), then cries/becomes pink once detaching from the breast

Question 11

Will present as a child who becomes blue/hypoxic while breast feeding
(because he can’t breathe through the nose), then cries/becomes pink
once detaching from the breast?

Answer 11

Choanal atresia.

Question 12

Choanal atresia. how made diagnosis?

Answer 12

Similar to TEF, diagnosis is made via insertion of nasogastric tube.

Question 13

Choanal atresia. part of what syndrome?

Answer 13

Part of CHARGE syndrome

Question 14

CHARGE syndrome?

Answer 14

Part of CHARGE syndrome -> Coloboma of the eye (hole in the eye), Heart defects, Atresia of the choanae, Renal defects, Genitourinary
anomalies, Ear anomalies

Question 15

Congenital diaphragmatic
hernia. one of the highest yield ped condition.

Cause?

Answer 15

Caused by failure of formation of pleuroperitoneal membranes.

Question 16

Caused by failure of formation of pleuroperitoneal membranes?

Answer 16

Congenital diaphragmatic
hernia.

Question 17

Congenital diaphragmatic
hernia. occur on what side?

Answer 17

Always occurs on the left, where bowel from the abdomen can herniate
up into the left-chest.

Question 18

Always occurs on the left, where bowel from the abdomen can herniate
up into the left-chest?

Answer 18

Congenital diaphragmatic
hernia.

Question 19

Congenital diaphragmatic
hernia. CP? regarding bowel sounds

Answer 19

Can present as decr. bowel sounds in the abdomen + incr. bowel sounds in the
left hemithorax

Question 20

Congenital diaphragmatic
hernia. what vignette might say?

Answer 20

Vignette might say there are cystic-appearing areas in the left hemithorax seen on CXR (loops of bowel).

Question 21

Neonatal respiratory distress syndrome (NRDS).
definition? what case, what weeks born?

Answer 21

Aka hyaline membrane disease.

The answer on USMLE for respiratory distress in kid who is born <34 weeks’ gestation.

Question 22

NRDS. cause pathophysiology?

Answer 22

Due to insufficient surfactant production by type II pneumocytes due to
decr. lamellar bodies (the specialized organelles that produce surfactant).

Question 23

NRDS. lecithin/sphingomyelin?

Answer 23

These kids have decr. lecithin/sphingomyelin ratio (i.e., <2.0). Normally it is >2-2.4.

Question 24

NRDS. another name for lecithin?

Answer 24

dipalmitoyl phosphatidylcholine

Question 25

NRDS. USMLE can give simple vignette of NRDS and then ask for various manipulation of the ratio – i.e., “­ incr. sphingomyelin” might be an answer (makes sense, since this would decr. the ratio)

Answer 25

.

Question 26

NRDS. decr. surfactant --> ? --> elastics?

Answer 26

Decr. surfactant production means decr. alveolar compliance and ­INCR. elastic recoil. Surfactant is hydrophobic and normally prevents the alveoli from collapsing, so if it’s deficient, the hydrophobic interactions of the alveolar walls enable incr. collapsing/elastic recoil.

Question 27

NRDS. CXR? buzzy

Answer 27

CXR shows a “reticulogranular” appearance. Very buzzy and HY.

Question 28

NRDS. what is done in order to prevent it?

Answer 28

In order to prevent NRDS, a pregnant woman giving birth <34 weeks’ gestation must be TWO boluses of corticosteroids within 24 hours of parturition, which accelerate fetal lung maturity.

Question 29

NRDS. For example, there is a 2CK Q where they tell you a woman giving birth at 33 weeks’ gestation was given a bolus of corticosteroids 12 hours ago. They ask for next best step -->?

Answer 29

answer = “bolus of corticosteroids.” Sounds weird because they said it was just done, but she needs TWO boluses

Question 30

NRDS. management sequence? 3/4

Answer 30

Tactile stimulation --> place under warming lights --> exogenous surfactant and oxygen

Question 31

NRDS. what is tactile stimulation?

Answer 31

warming, drying, and rubbing the back or the soles of the feet -----> stimulates spontaneous breathing

Question 32

Tactile stimulation --> place under warming lights --> exogenous surfactant and oxygen. in what pathology?

Answer 32

NRDS.